Heart Failure with Preserved Ejection Fraction (HFpEF): The Overlooked Form of Heart Failure

December 30, 2025

Heart Failure with Preserved Ejection Fraction (HFpEF): The Overlooked Form of Heart Failure

Verified By
KIMS-SUNSHINE
Specialist,
30 December, 2025

$Learn more about heart failure with [reserved ejection fraction- its symptoms, causes, diagnostic criteria used and treatment approaches followed at present in this blog.$

Heart failure is a chronic condition where an individual’s heart continues to work but it is not at the same rate as before. This means blood will be pumped, but it will be a lot slower- fluids will accumulate in higher amounts in the extremities and in the lungs. In the long term, this places too much stress on the heart and the other organs in the body like the kidneys. There are 2 types of heart failure- based on the ejection fraction or amount of blood that fills up in the heart and is pumped to different parts of the body and how well the heart muscles themselves contract. If the volume of blood pumped out of the contracting heart is on the lower end, then it is called heart failure with reduced ejection fraction. For some individuals however, the heart chambers are stiff and don’t work normally, but the amount of blood pumped out remains in the normal range. This is when it is called heart failure with preserved ejection fraction.

HFpEF Symptoms

In medical terms, when the amount of blood pumped out from the left ventricle is lower than average, it is termed low ejection fraction. The symptoms of HFpEF include-

Chest pain and shortness of breath
Not being able to exercise as intensely as before
Fatigue is common
Swelling due to fluid accumulation in the extremities
Not being able to breathe normally if you are lying flat on a surface

HFpEF can be caused due to pre-existing heart disease, if a person is obese, hypertensive or diabetic. Individuals with chronic kidney disease are also at high risk of developing HFpEF. While the exact cause for why heart muscles and chambers begin to stiffen is not known, it is understood that this is a gradual process that occurs over many years. But, breathing related problems are often observed and can even cause obstructive sleep apnoea in affected individuals.

HFpEF Diagnosis Criteria

The diagnostic criteria aim to measure how well the heart is functioning by taking a close look at its pumping mechanism. An ECG or echocardiogram is very helpful in visualising ejection fraction and diastolic dysfunction. Stress tests are done for better understanding of how the heart pumps under duress. Heart catheterisation and cardiac MRI may be recommended in certain cases too.

Treatment For Diastolic Dysfunction

Treatment for this condition involves the usage of diuretics to reduce fluid accumulation. Blood pressure needs to be controlled, so medications for that are given if an individual has high blood pressure. Beta blockers and some inhibitory drugs which have been recently approved by the FDA help in managing symptoms long term. Taking good care of yourself by focusing on a heart friendly diet, regular moderate bouts of exercise and reducing sodium intake can help both the heart and kidney function better and reduce strain on both these crucial organs.

Conclusion

Heart failure is normally classified into different stages, depending on the severity of symptoms observed and felt. Stage A involves making changes in lifestyle and some drugs. Stage B uses antagonists and inhibitors for drugs. Surgery is required in some cases with advanced stages. Talk to a cardiac specialist about your symptoms and try to understand how your condition can be managed effectively. Call us for a consultation today!

Frequently Asked Questions

What is HFpEF?

HFpEF stands for heart failure with preserved ejection fraction. It is a form of heart failure where the heart pumps out a normal proportion of blood but is stiff and does not relax properly. This reduces the heart’s ability to fill with blood, leading to increased pressure in the heart and lungs.

What symptoms suggest HFpEF?

Symptoms include shortness of breath during activity or at rest, fatigue, reduced exercise tolerance, swelling of the ankles or legs, rapid weight gain from fluid retention, and difficulty breathing when lying flat. Some people also experience disturbed sleep due to breathlessness.

How is HFpEF diagnosed?

Diagnosis is based on symptoms, medical history, physical examination, and heart tests. An echocardiogram is used to show preserved ejection fraction and signs of impaired filling. Blood tests, electrocardiograms, and imaging of the heart may also be used to assess contributing conditions.

Is HFpEF reversible?

HFpEF is not usually reversible, but symptoms and progression can be controlled. Treatment focuses on managing underlying conditions such as high blood pressure, diabetes, obesity, and heart rhythm disorders, along with reducing fluid overload.

Can HFpEF lead to hospitalisation or complications?

Yes, HFpEF can lead to repeated hospital admissions due to fluid overload or breathlessness. Complications include atrial fibrillation, kidney dysfunction, reduced quality of life, and increased risk of cardiovascular events. Early diagnosis and ongoing management reduce these risks.